Wednesday, May 18, 2011

A couple of additional thoughts on the “concierge model” of primary medical care, which I wrote about a few days ago.

My primary care doctor went to that model of practice about a year ago, and I left his care when he did so. It was not that I could not afford the fee, I could actually, it was just that I didn’t wish to participate in that form of practice. If doctors are overworked, then that is a problem which needs to be addressed, but I am convinced that this idea is not the solution.

The greatest ill facing our health care delivery system today is the cost that we pay for it, and this process is akin to trying to put out a fire by pouring gasoline on it. While it may marginally improve health care for a few, it degrades the quality of health care for many, thereby damaging the system as a whole, and it adds enormously to the systematic cost.

The “concierge fee” is not really “money for doing nothing” as I suggested before, it is an “availability fee” that the patient pays to assure that the doctor will forgo seeing other patients to spend more time with the few. Still, no actual service is performed for that fee, since the doctor continues to charge the usual fee for services rendered. When an attorney charges a retainer, later services are deducted from that retainer. When he takes a contingency fee, he risks losing the case and getting nothing. With the concierge fee there is neither risk or deduction of later services, so I have to see that fee as an “overhead” charge.

As such, being “overhead,” that fee certainly adds to the cost of health care in this nation. If the average fee is $2,000 as the San Diego Union-Tribune article says, and the average number of patients is 450 for each of 3,500 concierge doctors in the U.S., then $3.15 billion, that’s billion with a ‘b,’ is being added to the cost of health care annually by that fee. That’s added to a health care system that was already the world’s most costly.

If each of those doctors dropped 1,700 patients when he established his concierge practice, then 5.95 million new patients were dumped into a system which has 3,500 fewer primary care physicians, and there was already a shortage of them to begin with. How can that not damage the system when there is a large number, millions, of additional patients being shared by fewer doctors?

This “concierge medical practice” is a thoroughly pernicious scheme.

My father was a physician, one who tended not to send a bill to patients when he knew that they would be unable to pay it. He didn’t want to stress them out over their inability to pay and he would, of course, continue to treat them after not sending them the bill. I think he would be horrified by this process, and I know that I am.

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About Me

I grew up in the Air Force, and served in diesel-electric submarines during the Cold War. I worked in the steel industry until it sort of died in the 80's, then in landscape management until recently, when health issues demanded retirement.

I believe government should intrude in the lives of its citizens to the minumum possible degree, but I also know that it must be big enough to
"get the job done." To me the job of government includes concepts that are usually thought of as liberal such as stringent regulation of necessary monopolies, regulating all business enough to prevent it from becoming predatory, providing necessary
comfort to citizens who are rendered destitute by calamity outside their reasonable control, and protection of our environment and natural resources.